CHAPTER © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 1 Laboratory and Equipment Safety.

CHAPTER

© 2011 The McGraw-Hill Companies, Inc. All rights reserved.

1Laboratory and

Equipment Safety


45-2

Introduction

• Laboratory testing – integral part of patient care

• Medical assistant must know – Common laboratory

equipment

– Safety in the laboratory

– Steps to prevent accidents

• CLIA ’88 – impact on laboratory setting– Quality assurance

– Quality control procedures

– Required record keeping


45-3

Role of Laboratory Testing in Patient Care

• Analysis of blood, urine, and other body fluids– Regular monitoring to

identify diseases or other problems

– Confirm initial diagnosis

– Determine and monitor dosage of a medication


45-4

Role of Laboratory Testing (cont.)

• Kinds of laboratories– Reference

laboratory • Owned and operated

by an organization outside the practice

• Have technological resources beyond the POL

– POL• Quicker turnaround• Eliminates need for

patient travel to other test location

Some managed care companies require their subscribers to use a specific reference laboratory.


45-5

Role of Laboratory Testing (cont.)

• Purpose of POL– Accurate and timely processing of routine

tests– Reporting test results to physician– Tests

• Chemical analysis• Hematologic tests • Microbiologic tests• Urinalysis


45-6

Apply Your Knowledge

Compare a reference laboratory and the POL.

ANSWER: A reference laboratory is a lab facility usually run by an organization separate from the practice. It has technologies beyond the POL. Patients have to travel to this facility. A POL provides quicker turnaround on results but is limited in the testing that can be performed. Patients are able to have testing done during an appointment without leaving the office.

Super!


45-7

Medical Assistant’s Role

• Processing tests done in POL

– Preparing the patient

– Collecting the sample

– Completing the test

– Reporting and documenting the results

– Communicating information about the

test


45-8

Medical Assistant’s Role (cont.)

• Additional responsibilities

– Understand regulations

– Accident prevention

– Waste disposal

– Housekeeping and maintenance

– Quality assurance and control

– Record keeping

– Inventory and order equipment and supplies

– Use reference materials

– Screen and follow-up results


45-9


What are the duties of a medical assistant related to testing done in the POL?

ANSWER: The medical assistant duties may include preparing the patient, collecting the sample, running the test, reporting the results, and, once the physician has reviewed the results, communicating the results to the patient.


45-10

Use of Laboratory Equipment

• You may routinely use the following: – Autoclave– Centrifuge– Microscope– Electronic equipment– Equipment used for

measurement


45-11

Use of Laboratory Equipment (cont.)

• Autoclave – sterilizes surfaces of instruments and equipment

• Centrifuge – spins and separates specimen into its component parts


45-12


• Optical microscope

– Uses light, concentrated through a condenser and focused through the object, to project an image

– Compound microscope – two lenses magnify the image created by condensed light


45-13

Microscope

• Oculars– Eyepieces

• Monocular• Binocular

– Contain a magnifying lens – magnify image 10 times (10X lens)

• Objectives– Contain another

magnifying lens– Moved under

ocular when needed

– Three objectives• Two dry • One oil-immersion

Microscope


45-14

Microscope (cont.)

• Arm and focus controls– Arm – attaches

oculars and objectives to body

– Focus controls – used to focus the object

• Light source – Under stage and

substage– Adjustable intensity

• Stage and substage – Stage – platform for

slide– Substage – condenser

• Specimen slides/ coverslip

Microscope


45-16


• Using an optical microscope–Operate correctly

–Care and maintenance• Clean after each use

• Store under plastic cover

• Move by holding arm and supporting the base


45-17


• Electronic equipment and software– Used to create and

maintain clinical data

– More accurate, safer, and more efficient than manual methods

– Photometer – measures light intensity

• Equipment used for measurement– Pipettes– Flasks or beakers– Hemocytometer – Thermometers


45-18


Matching:

___ Measures light intensity A. Focus controls

___ Platform for slide B. Hemocytometer

___ Contains magnifying lens C. Stage

___ One is an oil-immersion D. Photometer

___ Condenser to concentrate light E. Ocular

___ Move body tube up and down F. Substage

___ Calibrated to count cells G. Objective

ANSWER:

G

F

E

D

C

B

ANice Job!


45-19

Safety in the Laboratory

• Primary concern

• OSHA – Protection of employees in the workplace– Specific guidelines – General duty clause

• If no specific guidelines• Workplace free from recognized hazards

– Enforces guidelines from CDC


45-20

OSHA Guidelines

• Standard Precautions

• Hazard communication standards

• OSHA Bloodborne Pathogens Standard

• Hazardous Waste Operations and

Emergency Response Final Rule

• Needlestick Safety and Prevention Act


45-21

Standard Precautions

• Assume that all blood, blood products, human tissue, and body fluids are contaminated

• PPE guidelines– Gloves– Eye protection

• Use equipment appropriately

• Proper biohazard disposal


45-22

Hazard Communication

• Biohazard labels

• Material Safety Data Sheets (MSDS)

• Hazard labels– Name of material

– Hazardous effects


45-23

Safety in the Laboratory (cont.)

• OSHA Bloodborne Pathogens Standard– Written OSHA Exposure Control Plan

– Training • Blood-borne pathogens• PPE • Universal Precautions• Prevention of exposure

– Hepatitis B vaccination


45-24


• Hazardous waste– Dispose in proper

containers• Sharps

• Other biohazardous waste

– Location of containers

– Reduce spillage

• Needlestick Safety and Prevention Act– Revision of

Bloodborne Pathogen Standard

– Use of devices to reduce risk


45-25

Accident Prevention Guidelines

• Physical safety– Common sense– PPE– Manufacturers’ guidelines

• Fire and electrical safety– Fire drills– Fire extinguishers– Reduce electrical hazards


45-26


• Chemical safety– MSDS– PPE

• Biologic safety– Standard

Precautions– Disinfection – Waste disposal

• Accident reporting– Office

procedures– Ensure safety/

first aid– Clean up


45-27


• Housekeeping– Reduce risk of disease transmission– Guidelines

• Written policies and procedures• Clean up spills/splashes

immediately• Clean equipment after use• Dispose of waste correctly


45-28


What information must be included on the MSDS?

ANSWER: MSDS must include: Name of the product Chemical and common name of ingredients Chemical characteristics of the products Physical hazards Health hazards Guidelines for safe handling Emergency and first-aid procedures for exposure


45-29

Quality Assurance Programs

• Monitor the quality of patient care– Ensure safety of

workers– Assess the quality of

tests performed

• Clinical Laboratory Improvement Amendments (CLIA)– Regulation of

laboratories– Test categories

• Certificate of Waiver• Moderate complexity• High complexity


45-30

CLIA

• Certificate of Waiver Tests – Pose insignificant risk to the patient if they are

performed or interpreted incorrectly

– Simple and accurate, so the risk of obtaining incorrect results is minimal

– Approved by the FDA for home use


45-31

CLIA (cont.)

• Moderate-complexity tests– 75% of tests– Qualified laboratory

personnel– Random inspections

• High-complexity tests– Tests for specialties

and subspecialties – Qualified laboratory

personnel– Random inspections


45-32

Components of Quality Assurance

• Quality control program– Adherence to procedures– Careful documentation

• Instrument and equipment maintenance

• Proficiency testing

• Training and continuing education

• Standard operating procedures documentation


45-33

Quality Control and Maintenance

• Ensure accuracy in test results by carefully monitoring test procedures

• Procedures– Equipment calibration

– Use control samples

– Perform reagent controls

– Maintain equipment

– Documentation of above procedures


45-34

Quality Control and Maintenance (cont.)

• Equipment maintenance– Manufacturer’s guidelines– Troubleshooting a problem –

investigating the cause using a systematic approach

• Documentation– Quality control log– Reagent control log– Equipment

maintenance log

– Reference laboratory log

– Daily workload log


45-35

Proficiency Testing

• Proficiency testing program– Accuracy of test results– Adherence to standard operating procedures

• Control sample, documentation sent to proficiency testing organization– Pass – continue performing test– Fail – discontinue performing tests


45-36

QA Programs

• Training, continuing education, and documentation– Employer responsibility– Reference material

• MSDS/safety manuals/SOPs• Manufacturers’ user or reference guides• Clinical Lab Technical Procedure Manuals• Regulatory documentation (OSHA, CLIA

’88)• Maintenance and housekeeping schedules


45-37

QA Programs (cont.)

• Requisition forms

– Medical assistant’s responsibility

– Complete information

– Include with specimen or send with patient to laboratory


45-38


What is the purpose of a quality assurance program for a laboratory?

ANSWER: The purpose of a QA program for a lab is to monitor the quality of patient care, ensure safety of workers, and assess the quality of tests performed.

QualityAnswer!


45-39

Communicating with the Patient

• Before testing– Patient preparation– Verification of patient preparation

• During specimen collection– Proper patient identification– Verbal and nonverbal

• After specimen collection– Postprocedure instructions– Schedule for further testing, if needed


45-40

Communicating with the Patient (cont.)

• Test results– Report to physician for interpretation

– Report to patient, if instructed to by the physician

– Patient questions• Answer if within your scope

• Refer to physician


45-41

Record Keeping

• Quality control and equipment maintenance

• Inventory control

• Record test results in patient records

• Tracking of specimens


45-42

Record Keeping (cont.)

• Patient records– Identify unusual

findings– Follow office

procedures

• Specimen identification– Patient information– Person who

collected specimen– Physician

Patient: Jason JonesDOB: 10/22/0000Date / time: 04/14/0000 @ 9:00 AMCollected by: shf Physician: M. Welby


45-43


1. Mr. Jones called for his laboratory results but the physician has not reviewed the results. What should the medical assistant do?

ANSWER: The medical assistant should tell Mr. Jones that the physician has to review the results before releasing them to the patient. She should also tell Mr. Jones that she or the physician will call with the results once they are reviewed.

2. When she reviews Mr. Jones’ laboratory results, she notes that his glucose is elevated. What should the medical assistant do?

ANSWER: She should identify the test result that is out-of-range by circling or underlining it based on office policy.

Bravo!


45-44

In Summary

45.1 The physician’s office laboratory (POL) is responsible for accurate and timely processing of routine tests and for reporting test results to the physician.

45.2 The medical assistant’s duties in an office laboratory include preparing the patient for the test, collecting the sample, completing the test, reporting the results to the physician, and communicating information about the test to the patient.

45.3 Common laboratory equipment includes autoclaves, centrifuges, microscopes, electronic equipment and software, and equipment used for measurement.


45-45

In Summary (cont.)

45.4 Follow specific steps for operating a microscope, including plugging it in, cleaning the lenses, placing the slide on the stage, adjusting the focus, examining the image, and cleaning the lens before storage.

45.5 Regulatory controls governing the physician’s office laboratory include Standard Precautions, Hazard Communication Standard, OSHA Bloodborne Pathogens Standard, Hazardous Waste Operations and Emergency Response Final Rule, and the Needlestick Safety and Prevention Act.


45-46

In Summary (cont.)

45.6 Preventing accidents in the physician’s office laboratory should include physical, fire and electrical, chemical, and biologic safety measures.

45.7 The goal of a quality assurance program in a physician’s office laboratory is to monitor the quality of the patient care that a medical laboratory provides.

45.8 The medical assistant might be responsible for recording information about quality control and equipment maintenance, inventory control, test results in patient records, and tracking every specimen that he or she handles.


45-47

In Summary (cont.)

45.9 Hazardous waste must be disposed of in properly constructed and labeled containers. Containers for sharps must be puncture-proof, leak-resistant, and rigid, and needles should be dropped into the sharps container without bending, breaking, or recapping them.

45.10 Quality assurance and quality control programs serve to reduce testing errors and provide for the safety of laboratory personnel.

45.11 Accurate quality control documentation in a physician’s office laboratory includes a reference laboratory log and a daily workload log.


45-48

In Summary (cont.)

45.12 Common reference materials used while performing procedures in a physician’s office laboratory include Material Safety Data Sheets, standard operating procedures, safety manuals, equipment manufacturers’ user or reference guides, Clinical Laboratory Technical Procedure Manuals, regulatory documentation, and maintenance and housekeeping schedules.

45.13 It is the medical assistant’s responsibility to ensure that patients understand what is expected of them before a test. Providing clear pretest instructions in both oral and written form is an essential part of the test procedure.


45-49

End of Chapter 45

Quality is not an act, it

is a habit.

~ Aristotle

CHAPTER © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 1 Laboratory and Equipment Safety.

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